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A CASE ANALYSIS OF

SCHIZOPHRENIA, UNDIFFERENTIATED

In Partial Fulfillment
Of the Requirements in Subject
NCM 106 RLE

Submitted to:
Prof. GeorgineManantan RN, MT, MSN
BSN Level IV Clinical Instructor

Submitted by:
BSN Level IV Student

Table of Contents

I.

Introduction

II. Demographic Data


III. Anatomy and Physiology
IV. Assessment
V. Diagnostic Procedures
VI. 5NCP
VII. Drug Studies

I. Introduction
Schizophrenia is a chronic and severe mental disorder that affects how a person
thinks, feels, and behaves. Schizophrenia is a puzzling mental disorder that makes the
client difficult to distinguish between what is real and unreal, think clearly, manage
emotions, relate to others, and function normally. Clients with schizophrenia may seem
like they have lost touch with reality but it doesn't mean there isn't hope. Schizophrenia
can be successfully managed. The first step is to identify the signs and symptoms. The

second step is to seek help without delay. With the right treatment and support, a
person with schizophrenia can lead a happy, fulfilling life.
Clients with schizophrenia often have an altered perception of reality. They may see
or hear things that dont exist, speak in strange or confusing ways, believe that others
are trying to harm them, or feel like theyre being constantly watched. This can make it
difficult to negotiate the activities of daily life, and people with schizophrenia may
withdraw from the outside world or act out in confusion and fear.
Although schizophrenia is not as common as other mental disorders, the symptoms
can be very disabling. It is a long-term mental disorder of a type involving a breakdown
in the relation between thought, emotion, and behavior, leading to faulty perception,
inappropriate actions and feelings, withdrawal from reality and personal relationships
into fantasy and delusion, and a sense of mental fragmentation.
There are many kinds of Schizophrenia like paranoid, catatonic, disorganized,
residual or undifferentiated. When a person is exhibiting symptoms which meet many of
the symptoms of schizophrenia, but does not fully or clearly fit one of the other types
ofschizophrenia(paranoid, catatonic, disorganized or residual), then the client is given a
diagnosis of undifferentiated schizophrenia.

II. Demographic Data

Name: Cerbiano, uw Melissa


Past Address: Butuan City
Temporary Address: Quezon City General Hospital, Seminary Rd.
Birth Date: 03/02/1973
Age:19 years old(According to Client)
43 years old (According to Records)

Gender:Female
Religious Affiliation:Roman Catholic
Marital Status:Single
Fathers Name: Agustin Dulia
Mothers Name: Serena Pioro
Informant: Veneianda Leal
Pavillion:5
Chief Complaint:Post-partum Psychosis
Provisional Diagnosis:Schizophrenia, Undifferentiated
Attending Physician:Dr. Joeffrey L Cruzada

III. Anatomy and Physiology


The neurologic system consists of two main divisions, the central nervous
system (CNS) and the peripheral nervous system (PNS). The autonomic nervous
system (ANS) is composed of both central and peripheral elements. The CNS is
composed of the brain and spinal cord. The PNS is composed of the 12 pairs of the
cranial nerves and the 31 pairs of the spinal nerves. The ANS is comprised of visceral
efferent (motor) and the visceral afferent (sensory) nuclei in the brain and spinal cord.
Its peripheral division is made up of visceral efferent and afferent nerve fibers as well as
autonomic and sensory ganglia. The brain is covered by three membranes brain
membrane. The dura matter is a fibrous, connective tissue structure containing several
blood vessels. The arachnoid membrane is a delicate serous membrane. The pia matter
is a vascular membrane. The spinal cord extends from the medulla oblongata to the
lower border of the first lumbar vertebrae. It contains millions of nerve fibers, and it
consists of 31 nerves 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral. Cerebrospinal

fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia matter. It flows
through the foramen of Monro into to the third ventricle, then through the aqueduct of
Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen of Magendie
and the two foramens of Luska. It then flows into the cistema magna, and finally it
circulates to the subarachnoid space of the spinal cord, bathing both the brain and the
spinal cord. Fluid is absorbed by the arachnoid membrane.
The cerebrum is the center for consciousness, thought, memory, sensory
input, and motor activity; it consists of two hemispheres (left and right) and four lobes,
each with specific functions. The frontal lobe controls voluntary muscle movements and
contains motor areas, including the area for speech; it also contains the centers for
personality, behavioral, autonomic and intellectual functions and those for emotional
and cardiac responses. The temporal lobe is the center for taste, hearing and smell, and
in the brains dominant hemisphere, the center for interpreting spoken language. The
parietal lobe coordinates and interprets sensory information from the opposite side of
the body. The occipital lobe interprets visual stimuli. The thalamus further organizes
cerebral function by transmitting impulses to and from the cerebrum. It also is
responsible for primitive emotional responses, such as fear, and for distinguishing
between pleasant and unpleasant stimuli. Lying beneath the thalamus, the
hypothalamus is an automatic center that regulates blood pressure, temperature, libido,
appetite, breathing, sleeping patterns, and peripheral nerve discharges associated with
certain behavior and emotional expression. It also helps control pituitary secretion and
stress reactions.The cerebellum or hindbrain, controls smooth muscle movements,
coordinates sensory impulses with muscle activity, and maintains muscle tone and
equilibrium. The brain stem, which includes the mesencephalon, pons, and medulla
oblongata, relays nerve impulses between the brain and spinal cord. The spinal cord
forms a two-way conductor pathway between the brain stem and the PNS. It is also the
reflex center for motor activities that do not involve brain control. The PNS connects the
CNS to remote body regions and conducts signals to and from these areas and the
spinal cord. The ANS regulates body functions such as digestion, respiration, and
cardiovascular function. Supervised chiefly by the hypothalamus, the ANS contains two
divisions. The sympathetic nervous system serves as an emergency preparedness
system, the flight-for-fight response. Sympathetic impulses increase greatly when the
body is under physical or emotional stress causing bronchiole dilation, dilation of the
heart and voluntary muscle blood vessels, stronger and faster heart contractions,
peripheral blood vessel constriction, decreased peristalsis, and increased perspiration.
Sympathetic stimuli are mediated by norepinephrine. The parasympathetic nervous
system is the dominant controller for most visceral effectors for most of the time.
Parasympathetic impulses are mediated by acetylcholine.

Psychopathology of Schizophrenia Psychosocial Stressor and interpersonal


events
Modifiable
Factors:

Lifestyle
Alcohol
Smoking
Substance
abuse

Stimulated by different
Failure in development or
a subsequent loss of
brain tissue
Diminished glucose Meta, and
oxygen in frontal cortical structures

Decrease brain volume and


abnormal
brain function in frontal
of the brain
and temporal lobe
Transmission of signal
requires a complex
series of biochemical
events

Malfunctioning of transmission
of electrical impulses

Non-Modifiable:

Age
o
o

Male (1525)
Female (2535)

Enlarged
ventricles
and
cortical
atrophy

Actions of:
Dopamine
Serotonin
Norepiephrin
e
Acetylcholine
Glumate

Drug increases
dopaminergic
system activity

Induced
paranoid
psychotic
symptoms

Drug blocking
post synaptic
dopamine
receptors

Reduce
psychotic
symptoms

Three separate symptoms


complexes/syndromes:
Hallucinations/delusions
Disorganized thoughts and
behavior

IV. Assessment
A HISTORY OF PRESENT ILLNESS
The symptoms started to be noted as she was seen by a MMDA Rescue Team
member on June 25, 2013, 11:00 a.m.
Problems on clients behavior are often like per minute.
The mental illness was documented to be manageable.
The client was cooperative but disoriented.
The mental illness occurred as she was having a conversation.
The complaint as the client was admitted was vulvar hematoma, Anemia
secondary to acute blood loss and Psychosis.
The environmental factors and physiological factors had negative effects on the
client health problem.
The client could not participate in complex activities.
B PAST HEALTH HISTORY
Vulvar hematoma and Anemia secondary to acute blood loss were recorded
injury of the client.
Hospitalization on June 25, 2013 at QCGH.
C FAMILY HISTORY

Fathers Name: Agustin Dulia


Mothers Name: Serena Pioro

PATTERNS OF FUNCTIONING

A PSYCHOLOGICAL HEALTH
1 Coping Patterns
o Who are the people significant to you?
o SilaJoselitoPablito, pamangkinko, mgakapatidko at anakko..
o Who can and do you talk on a regular basis?
o Sa mgakaibiganko, naguusap kami.
o How much time do you spend alone?
o Di namanakonagiisamadalas.
o How many people do you relate to each day?
o Madami
o Do you exercise regularly?
o Araw-arawnageexerciseako.
o What type of exercise?
o Sasayaw o kaya naglalakad-lakad.
o Note non-verbal communications (eye contact, gestures, body
language, tone of voice, affect)
o Inderect eye contact, small gestures, difficulty to move, soft tone of
voice, flat affect at times.

o
o
o
o
o
o
o
o
o
o

2 Interaction Patterns
Who are the people in your family?
Wala akongpamilya, anakko lang.
How do you usually express your feelings and though to others?
Salitaako.
o What do you think about voicing your opinion or feelings to family? To
friends?
Ok lang.
o What do you do when others make plans that you arent particularly
interested in?
Ok lang.
Who initiates activities with family? with friends?
Di koalam.
How do you feel about the way you interact with others?
Masaya naman.

3 Cognitive Patterns
o How much formal education have you had?
o Di akonakapag-aral.
o What do you read?
o Mgasulat.
o Note verbal ability (concrete thought, simple sentences, formal
operational thought, complex sentences, vocabulary used, and ability
to conceptualize).
o Sometime the client has flight of ideas and incoherent answers. The
client could not conceptualize idea on her own
4 Self-Concept
o How do you feel about your weight and appearance?
o Ok naman.
o What have you change in your physicality?
o Mas luministsakanawalamgasugatsugat.
o What do you feel about the changes in your physicality?
o Maaliwalas.
o How have those changes affected your relationships with friends?
o Hindi naman.
o The way you look at yourself? How do you see yourself in relation to
other people?
o Ok lang, parehas lang.
o What religion and social values were you raised with? Are you
comfortable with those beliefs and values now?
o Dasalako. Ok langnaman.
o How do you express your thoughts and feelings to others? Are there
some situations when you dont? When?
o Sasalitaako. Lagiakosumasagot.
o What are your goals in the next five years? How do you plan to
achieve them?
o Papagaling. Opo.
o Describe some characteristics of the type of person you would most
like to be. Do you see yourself as that person? Is your description
realistic to you?
o Masaya. Opo.
o Observe the nature of the clients clothes (loose, fitted, clean, soiled).
Does client shield or avoid touching or looking at a certain area of the
body? What is the nature of any scars, deformed body parts or
alterations in function? When does the client interact with; what is the
clients affect? How client is groomed (hair, clothes, nails, teeth, skin).
o Fairly groomed, loose dress but poor eye contact and short attention
span.

5 Emotional Patterns
o What type of mood are you usually in?
o Masaya.
o How do you express yourself during mood changes?
o Kakanta, sasayaw at drawing.
o Do your relations with others change with your moods? How?
o Masaya.
o Are you satisfied with your usual mood?
o Ok naman.
o Are you satisfied with your behavior during mood changes?
o Ok naman.

6 Sexuality
o How do you express yourself as a man/woman?
o Babae.
o What do you enjoy/not enjoy about being a man or woman?
o Maganda
o What problems do you met as a woman?
o Nasasaktan.
o What is your occupation?
o Helper sa pantry.
o How has being a woman affected your work?
o Masaya.
o How do you show affection toward others?
o Masaya tsakangingiti.
o How do you want others to show affection to you?
o Masaya.
o Observe the persons identity and role behaviors (dress, gestures,
grooming, nonverbal behavior, nature of interactions with others)
o Fair grooming, short hair, poor eye contact and short attention span.
B Socio Cultural Health
1 Cultural Patterns

o What social values were you brought up with? With ones are important
to you now?
o Magdadasaltsakatutulong.
o What are/were the traditions with your friends? (family gatherings,
celebration, head of home, types of food eaten, religious activities,
health care practices).
o Sisimba
o Observe what type of clothes the client wears. How is the hair
groomed? Stylist?
o Fair grooming, short hair, poor eye contact and short attention span.
o
o
o
o
o

2 Significant Relationship
Who are the significant people in your life? Family? Friends?
Kaibigan, anak, pamangkintsakamgakapatid.
Anak, pero nag-aaralsiyangayon.
Who do you go to when you have a concern or need help?
Anak, pero nag-aaralsiyangayon.

3 Recreational Patterns
o What do you do for fun?
o Sasayaw, kakanta at drawing.
o How do you feel leisure time?
o Masaya.
o Do you have hobbies or interests outside of work?
o Sasayaw, kakanta at drawing.
o Do you have the resources to get involved with your interests?
o Hihintaymga nurse.
o How long has it been since you participated in any leisure activities?
o Matagalna.
o What do you think or feel about that?
o Ok lang.
o Observe for any leisure materials in the environment (books, craft
materials, woodworking, sport equipment, stereo, collections)
o No leisure materials
4 Environment
o What type of dwelling do you live in?
o Sa sahig.
o Are you comfortable where you live?
o Masakitsalikod.

o Do you feel you have enough space to yourself? Is your palce easy to
move around in?
o Malawak.
o Are there sounds, noises, or odors in the environment that are
concern to you?
o Wala naman.
o Do you have any pets? What kind?
o Aso
o Observe the appearance of dwelling in regard to safety, orderliness,
cleanliness, note steps, placement of rooms, shower or tub, and
availability, loose rugs; what are the usual sounds, noises and odors
of the environment.
o Safe, fairly clean, noted steps, congested rooms, available comfort
rooms and foul odor smell, days after cleaning.

o
o
o

C Spiritual Health
1 Religious Beliefs and Practices
o What era your religious practices?
o Katoliko.
What is your involvement with church groups and communities?
Nagdadasal.
o Do you have religious practices or do you practice the same religion
you grew up with? If not do you feel any conflict about this?
Nagdadasal. Maaliwalas.
2 Values and Valuing
o What things are important to your life?
o Anak
o How do you see yourself in relation to society?
o Masaya.
o What do you think about helping people you dont know? People you
do know?
o Maaliwalas
o Observe the indicators or values in the environment (orderliness,
safety, cleanliness, upkeep of furniture, belongings). The indicators of
values in interactions with others (open dialogue, praise for others,
active listening, touch). Observe for any books or pamphlets
regarding things valued by the client.

o Fairly groomed and self-organized.


II

Activities of Daily Living


Activities

1 Nutrition

2 Elimination
3 Exercise
4 Hygiene
5 Rest and Sleep

During
Hospitalization
Fruits e.g. banana,
Vegetables e.g.
cabbage, Meat e.g.
pork, rice and water.
Frequent
urination
and twice a day stool
elimination.
Exercise e.g. walking
and stretching every
morning.
Bathing with soap
once a day.
Sleep early and rise
early for work at the
pantry.

Analysis
Complete
Balanced Diet
Proper elimination
pattern.
Regular exercise
with
fairly-toned
physique.
Fairly
groomed
with body odor.
Enough rest and
correct
sleep
pattern.

1 Nutrition
o What kind of food can and do you eat?
o Prutas, kanin, gulay at giniling.
o How many meals do you eat per day?
o Tatlo.
o What is your knowledge of the four basic food groups?
o Prutas, kanin, gulay at giniling.
o Whom do you eat with?
o Kaibigan.
o Where do you eat your meals?
o Lamesa.
o Do you take daily vitamins? With iron? With minerals?
o Mgagamot.
o Observe: are height and weight proportional? What is the texture of hair?
Condition of scalp? What is the condition of nails? Gums? Teeth?
o Fairly proportioned height and weight. Hair texture is dry, short and straight.
Scalp is normal, no signs of parasites or dandruff. Nails are slightly elongated
and dirty.

2 Elimination
o How often do you urinate and have bowel movements?
o Madalasnaiihi at dalawasaisangarawdumudumi.

o
o
o
o
o
o
o
o
o
o

What does your urine look like (clarity, color)?


Cloudy and yellowish.
What is the smell of your urine for you?
Medyo may amoyna di maganda.
What do your bowel movements look like (consistency, color)?
Maitim at buo.
Do you need laxatives to have a bowel movement? Enemas?
Di koalam.
Do you experience pain during bowel movement?
Wala naman.

3 Exercise
o What kinds of physical activity do you engage in?
o Sasayaw at lalakad
o How long has it been since youve done them?
o Simulanungnanditoako.
o What type of work do you do for a living?
o Help akosa pantry
o Are you satisfied with the amount of exercise you get each week?
o Masaya naman.
o Observe: tone of the clients muscle, are height and weight proportional? Is
atrophy present?
o The client physique is slightly-toned with semi-proportional weight and height
without any atrophy present.
4 Hygiene
o Describe how you take care of your body.
o Liligoako at toothbrush.
o Howdo you prefer baths, showers, or sink baths?
o Shower.
o Morning or evenings?
o Sa umaga.
o How often do you brush your teeth?
o Bagomatulog at pagtaposgumising.
III

Physical Assessment

General: Conscious, Incoherent


Day:Wednesday
A Measurement

Date:July 27, 2016


Findings

Normal

Interpretation /
Analysis

Weight
Height
B Vital Signs
Temp
PR
RR
BP

67 kg.
5ft.

48-62 kg.
5ft.

Fairly Normal

370c
86 bpm
19 cpm
130/90 mmHg

36.5-37.50c
80-100 bpm
12-20 cpm
120/80 mmHg

Normal
Normal
Normal
Borderline
Hypertension

Head-To-Toe Physical Assessment


Body Parts /
Technique
SKIN

SCALP AND HAIR

HEAD AND FACE

NECK
LYMPH NODES
EYES

EARS

Normal
Findings
Evenly colored skin
tone, intact skin, no
reddened area, no
lesion, no edema, warm
temperature.
Skin pinches easily and
immediately returns to
its original position.
Clean and dry scalp.
Natural hair color,
Smooth and firm hair,
evenly distributed, no
lice, no dandruffs.

Actual
Interpretation /
Findings
Analysis
Evenly colored skin
NORMAL
tone, intact skin, no
reddened area, no
lesion, no edema, warm
temperature.
Skin pinches easily and
immediately returns to
its original position.
Hair is black with
NORMAL
minimal white hair
strands. Even
distribution of hair. No
dandruff observed. Hair
is curl.
Normocephalic and
Normocephalic, no
NORMAL
symmetrical No lesion
masses or tenderness
visible.
notes upon palpation.
No lesions present.
No palpable masses and
Uniform in color. No
NORMAL
no tenderness.
mass.
No tenderness, no
No tenderness, no
NORMAL
masses, no enlargement
masses, no
enlargement
Placed evenly,
Placed evenly,
NORMAL
symmetrical, nonsymmetrical, nonprotruding in eyes, pink
protruding in eyes, pink
and clear conjunctiva,
and clear conjunctiva,
white sclera, pupils are
white sclera, pupils are
reactive to light.
reactive to light..
Color is the same with
Color is same in face,
NORMAL
face, symmetrically
symmetrical and
aligned auricle with outer flexible. With no hearing
cantus of the eye, no
problem.

MOUTH

NOSE
POSTERIOR
THORAX AND
ANTERIOR
THORAX
UPPER
EXTREMITIES

LOWER
EXTREMITIES

hearing problem.
Lips are smooth, moist,
pinkish, no lesion or
swelling. 32 teeth and
ivory color. Gums are
pinkish, moist, firm and
no masses or lesion.
Midline tongue. Present
of gag reflex.
Symmetrical and
straight. No discharges
or flaring.
Symmetrical chest
expansion.
Equal in length, no
lesion, no deformities on
extremities and with
complete digits. Uniform
to body temperature
Equal in length, no
lesion, no deformities on
extremities and with
complete digits. Uniform
to body temperature.

Complete set of teeth,


oral mucosa and lips
are pink in color, moist
and there were no oral
ulcers.

NORMAL

Symmetrical, no
discharges.

NORMAL

Symmetrical chest
expansion.

NORMAL

Equal in length, no
lesion, no deformities
on extremities and with
complete digits.
Uniform to body
temperature
Equal in length, no
lesion, no deformities
on extremities and with
complete digits.
Uniform to body
temperature. Have
some rash on distal
anterior part of the right
feet.

NORMAL

Neuro Exam:
CN-I: Can smell
CN-II: 2-3mm equally reactive to light.
CN-III: Intact eye movement
CN-IV: Correct up and down movement of eyes.
CN-V: (+) Corneal Reflex and (+) facial sensations.
CN-VI: (+) Lateral eye movement.
CN-VII: No facial asymmetry.
CN-VIII: Can hear and (+) Balance,
CN-IX: (+) Salivating and swallowing.
CN-X: (+) Gag reflex.
CN-XI: Can shrug shoulders.
CN-XII: Tongue at midline and (+) tongue movement.

Can be caused by
parasites on the
environment or
poor lower
extremities
hygiene..

Reflexes:
++
++

++
++

100%
100%

100%
100%

Sensations:

VII

Diagnostic, Laboratory Results and Procedures

Chest X-ray: Essentially Normal Chest


Radiological Report: (-) Negative on skull fracture
ECG: Non-specific ST, T-wave changes

Date: 07-11-2003
Date: 07-11-2003
Date: 06-20-2008

Blood Chemistry
Examination

Date: 07-05-2013

Test

Result

Normal Values

FBS

4.35

3.9 5.8 mmol/L

Interpretation /
Analysis
NORMAL

BUN

3.17

2.1 7.1 mmol/L

NORMAL

Creatinine

68

53 97 mmol/L

NORMAL

Uric Acid

301.8

155 430 mmol/L

NORMAL

Cholesterol

3.80

3.6 5.7 mmol/L

NORMAL

Triglycerides

1.87

0.45 2.26 mmol/L

NORMAL

SGPT

17.8

3 31 U/L

NORMAL

SGOT

23.9

2 31 U/L

NORMAL

Complete Blood Count


Examination

Date: 07-05-2013

Test

Result

Normal Values

Hgb

131

120-160 g/L

Interpretation /
Analysis
NORMAL

Hct

0.39

0.36 0.42 g/L

NORMAL

RBC

4.51

4.0 6.0 x 1012/L

NORMAL

WBC

7.4

5.0 10 x 109/L

NORMAL

Neutrophil

0.63

0.45-0.65

NORMAL

Lymphocyte

0.32

0.02-0.35

NORMAL

Monocyte

0.04

0.02-0.06

NORMAL

Eosinophil

0.04

0.02-0.04

NORMAL